Appeals court blocks overhaul of VA mental health system

VCS Lawsuit in the news,Executive Director Quoted

From American Medical News


Judges say they have no authority to decide whether the agency provides adequate medical care, despite an earlier panel’s finding of “unchecked incompetence.”

By ALICIA GALLEGOS, amednews staff. Posted May 21, 2012.

Veterans groups are working on an appeal to the U.S. Supreme Court after a federal appeals court halted a revamping of the Dept. of Veterans Affairs’ mental health system. The 9th U.S. Circuit Court of Appeals said May 7 that it does not have jurisdiction to determine whether the VA’s practices are constitutional.

The decision reverses an opinion by a smaller panel of the same court ordering the government to implement significant reforms of its mental health services. The panel had said the VA exhibited “unchecked incompetence” in its approach to providing the services.

Patrick Bellon, executive director of Veterans for Common Sense, a plaintiff in the case, said his group was disappointed by the latest ruling but not surprised. The organization plans to file a prompt appeal.

“The expectation was that this was going to the Supreme Court,” he said. “Even if they ruled in our favor, [one] side would appeal. The real impact is that more veterans are going to suffer and languish in the system” while the case is still pending.

At this article’s deadline, messages and emails to the VA had not been returned.

Two veteran advocacy groups, Veterans for Common Sense and Veterans United for Truth, first sued the VA over this issue in 2007. The plaintiffs said the VA’s inadequate medical services violated veterans’ due process rights.

The groups blamed increasing suicides among veterans on a lack of timely medical care by the department and asked that the court order reforms of the VA system. According to court documents, veterans wait an average of more than four years to fully adjudicate a claim for mental health benefits. Attorneys for the VA said the courts did not have jurisdiction to rule over these claims.

Veterans can wait 4 years to fully adjudicate a claim for mental health benefits.

A California district court agreed with the government, finding that veterans’ rights were not constitutionally violated and that the court lacked authority to review the plaintiffs’ other claims. In 2011, a panel of the 9th U.S. Circuit Court of Appeals overturned the ruling.

The panel held that “the VA’s failure to provide adequate procedures for veterans facing prejudicial delays in the delivery of mental health care” violated their Fifth Amendment rights to due process. The mental health system needed immediate reform, the court said, but the VA requested that the entire court review the decision. In the full court’s opinion, judges said they sympathized with the veterans but that their hands were tied.

“As much as we as citizens are concerned with the plight of veterans seeking the prompt provision of the health care and benefits to which they are entitled by law, as judges we may not exceed our jurisdiction,” the court said. “Jurisdiction is power to declare the law, and when it ceases to exist, the only function remaining to the court is that of announcing the fact and dismissing the cause [of action]. We conclude that the majority of [the plaintiffs’] claims must be dismissed for lack of jurisdiction.”

VA reports improvements

Despite the latest ruling, Bellon believes the 5-year-old lawsuit has shed some light on the problem of mentally ill veterans and led to improvements within the VA’s health care system.

“Since we began the lawsuit, it seems like the VA has been more proactive in suicide prevention and that there’s some positive steps being made,” he said.

Two veteran groups blame increasing suicides among veterans on a lack of timely medical care by the VA.

In 2007, the VA launched the “Veterans Crisis Line,” a suicide hotline that has answered more than 500,000 calls and made more than 18,000 lifesaving rescues, according to the department’s website. In 2009, the department added an anonymous online chat that officials said has helped more than 28,000 people.

Studies on veteran suicide rates have come to varying conclusions. A 2011 report by the House Committee on Veterans’ Affairs concluded that 18 veterans commit suicide each day and that a third of them were receiving care from the VA at the time of their death. Each month, 950 veterans who attempt suicide are treated by the VA, according to the report.

Dept. of Defense data indicates service members took their lives at an approximate rate of one every 36 hours from 2005 to 2010. Another study, released in 2008 by the RAND Corp., said one in five service members who were deployed to Afghanistan or Iraq report symptoms of posttraumatic stress disorder or major depression.

VA officials say they’ve made dramatic strides in caring for veterans with posttraumatic stress disorder as well. In the last five years, the department has increased its screenings for PTSD and moved mental health treatment into the primary care setting so that all veterans coming in for care are evaluated, said Matthew J. Friedman, MD, PhD, executive director of the National Center for PTSD, a division of the VA. Health care staff also have developed social media tools to help spread information about PTSD to veterans and make it easier for them to find needed services in their area, he said.

“This is a very serious problem, and as with everything, we’re constantly trying to do better,” he said. “We’ve done a lot in terms of outreach, social media, lecture series. There’s a lot going on. Obviously, there’s a lot more to do.”

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